Hospital treatment is still a waiting game - The Sunday Times.

The NHS has succeeded in eliminating two-year waits, but in future the length of delays in treatment looks set to creep up again

Ollie Coburn does a job that shouldn’t exist. The 29-year-old from Stockport set up the social enterprise Freehab for local residents who are waiting for NHS treatment, offering consultation and advice to people with anything from sporting injuries to worn knees.

“There shouldn’t be a demand for our services,” he says. “People should be furious that they’re having to wait so long for treatment.”

Patients on NHS waiting lists are meant to be in the care of their GP but with primary care overburdened, many are having to turn to alternatives to get immediate help. And in Stockport few can pay at least £50 for a private consultation.

Freehab, which was set up after Covid impacted the local healthcare system, offers help for a voluntary contribution. It is serving the capital of backlog Britain, where some 17 per cent of the population — more than one in six residents — is waiting for NHS treatment, the worst rates in the country.

Last week NHS England proudly announced it had “virtually eliminated” two-year waits — “the first milestone in the most ambitious catch-up plan in health service history”. The number of patients waiting 18 months — the “next milestone” in the NHS’s elective recovery plan — has also fallen, from 75,992 in January to 53,911 in June.

In truth, the picture is far less rosy. The overall waiting list has increased again to 6.7 million people, while the number waiting more than a year is up 7 per cent in a month. The government wants to eliminate all year-long waits by 2025, yet this number stands at a whopping 355,774 — at least 15 times larger than the hurdle it has just crossed.

Some of Coburn’s clients at Freehab are elderly, waiting for operations that will let them resume a social life. Others are not. “We’re getting an increasing number of young people,” he said. “I’ve got an 18-year-old with terrible back pain who’s been waiting more than four months for an MRI scan.”

Many are waiting so long that secondary complications arise. “If you’re waiting for arthritis treatment, that’s affecting your ability to be active — then you can end up gaining weight. That comes hand in hand with increased risk of cardiovascular disease.”

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Many Stockport residents, such as 66-year-old Paula Lloyd, say they have been ignored.

The former school secretary was diagnosed with a hernia in June 2020. That October she was told she was on the NHS waiting list. “I was told I would hopefully have surgery within six months but I agreed to wait as my husband was undergoing cancer treatment. I was told I would be contacted the following April but nothing came. The appointments office assured me I hadn’t been forgotten about but I’m not so sure.”

A poll of 1,600 adults on the waiting list in October by Healthwatch England found that 48 per cent did not receive any support to manage their condition while they waited.

Dr Jaweeda Idoo, a local GP, faces dozens of calls from anxious waiters. “Patients are worried,” Idoo says. “If you’ve had that difficult conversation with your GP and get told that you’re unwell and need treatment, you just hope that you’ll get it fixed in a reasonable timeframe. There’s no way of knowing what number you are in the queue, and patients get frightened or distressed.”

Why is Stockport the epicentre for backlogs? The area has high deprivation, particularly in the north, where parts are in the top 1 per cent of deprivation nationally. In affluent Surrey Heartlands — which includes Guildford and Woking — just 4 per cent of people are on a list.

“These figures speak both to the government’s failure to tackle health inequalities, as well as its wilful mismanagement of the NHS for 12 years.” says Labour’s Andrew Gwynne, MP for Denton and Reddish, which includes parts of Stockport. The area’s waiting list, currently 51,000 people, was already about 30,000 before Covid hit.

The pandemic has not helped: Manchester had one of the highest rates of Covid admissions in the country. Jonathan Pearson-Stuttard is head of health analytics at Lane Clark & Peacock, an actuarial and consultancy service. “Areas that have struggled the most in the past two years — the northwest, which was consistently hardest hit — have seen the biggest impacts on waiting lists,” says Pearson-Stuttard. “Those areas are, because of Covid, now in greater need. So it’s a vicious cycle.”

Today, emergency departments are a pinch point. Just 61 per cent of patients visiting A&Es in the Stockport area are being seen within four hours, compared with the national level of 71 per cent.

“If you have an influx of patients into A&E well into the night, you don’t have the capacity to deal with the following morning’s elective list,” says David Maguire, senior analyst at the King’s Fund think tank. “You’ve used up the bed capacity.”

For this reason, Maguire believes a difficult winter will make it even harder to get through operating lists. “Those 18-month waits might creep back up to two years. We could be playing catch-up well into next spring.”

Many want to see regions co-operating more closely, with neighbouring trusts sharing resources — “mutual aid” — if they have drastically different-sized waiting lists.

Trusts used to be paid based on activity, meaning patients would typically be kept in their local hospital; experts hope the NHS’s new regional structure will help end the “postcode lottery” of NHS waits and let patients move more easily for treatment.

Hidden lists

During the pandemic the number of new monthly GP referrals for treatment plummeted from 1.6 million in February to 491,000 in April. It has only just returned to pre-pandemic levels.

People do not simply stop getting sick: rather, existing conditions are left undetected.

Analysis of NHS data suggests 6 million fewer people than usual have been referred since the start of the pandemic. If those people eventually seek treatment and hospitals do not step up their surgery rates, England’s waiting list could soar to 13 million.

Mapping this “unmet need” on top of existing waiting lists leads to striking conclusions. In Stockport, 100,000 people would end up on the waiting list, or about 34 per cent of the population. In nearby Heywood, Middleton and Rochdale, that figure would be 38 per cent.

Some are surprised the waiting list is not longer. In some cases, people who come forward now face barriers to even getting on the list.

Janice Tillett, a former Paralympian from Northampton, lives with Stickler syndrome, which affects eyes, ears and joints. The 50-year-old desperately needs a new knee but doctors wouldn’t put her on the waiting list because she was too young. “I should have more healthy years left,” she says. “I’ve been fobbed off. Then last August I was just pottering around my bungalow when I fell into agony. I couldn’t walk. I had to go through A&E just to see an orthopaedic person.”

She is on 20mg of morphine a day to manage the pain, yet regularly wakes in the night. “It’s my faith that’s keeping me going,” she said.

Eventually, she was told she would be allowed to join the waiting list in July — but given that she is the “lowest priority”, she was told she could be waiting one to three years.

Priority waits

Most agree that targeting the very longest waits is of vital importance. Some 57 per cent of patients on the list say their delay is adding to their pain, while 53 per cent said it limited their ability to carry out household tasks, according to Heathwatch.

“Five years ago, a 52-week wait would mean the chief executive getting a call from the health secretary,” says Maguire. Now there are 355,774 patients in that category.

Longer waits risk lives. “If someone living with diabetes is diagnosed later, they’ll likely be in poorer health by that point — and we know that early diagnosis with chronic diabetes will improve their chances of living longer,” says Pearson-Stuttard.

Yet the elective recovery plan is not without its critics. One senior NHS manager said the obsessive focus on eliminating two-year waits meant that patients with long waits were being prioritised at the expense of patients with shorter waits but greater needs, like cancer.

“The patients who are being referred in now, we’re not looking at them at all, to be honest,” they said. “It does worry me that we won’t get to them for a year’s time — what are we going to miss?”

Cutting cancer diagnosis waiting times is also an NHS priority, yet 327,395 people are on England’s cancer waiting list. The number waiting more than 104 days for treatment has doubled since June 2021, to more than 10,000.

Back in Greater Manchester, the local NHS has set up whileyouwait.org.uk, a website which gives people information on their options while they wait for treatment. “Unfortunately, long waiting lists for hospital treatment are likely to be with us for some time,” says Fiona Noden, co-chairwoman of the Greater Manchester elective care recovery and reform board. “We are prioritising those with the greatest need and who have waited the longest.”

Ollie Coburn fears that his services at Freehab will be needed well into the future to support the large share of Stockport that is left chronically ill.

“People are grumpy and fed up — but the worst thing is, I think we’re all getting acclimatised to these low standards,” he says. “People should be furious. Instead, this is the new normal.”

Original article:

https://www.thetimes.co.uk/article/hospital-treatment-is-still-a-waiting-game-pk5d85bfz

Credit:

Tom Calver, Data Projects Editor 

Shaun Lintern, Health Editor

The Sunday Times, August 14 2022

Image: Getty Images